Digital Smile Designed Computer-Aided Surgery versus Traditional Workflow in “All on Four” Rehabilitations: A Randomized Clinical Trial with 4-Years Follow-Up

The aim of the present study was to evaluate and compare the traditional “All on Four” technique with digital smile designed computer-aided “All on Four” rehabilitation; with a 4-years follow-up. The protocol was applied to a total of 50 patients randomly recruited and divided in two groups. Digital protocol allows for a completely virtual planning of the exact position of the fixtures, which allows one to perform a flapless surgery procedure with great accuracy (mini-invasive surgery) and also it is possible to use virtually planned prostheses realized with Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) (methods for an immediate loading of the implants. After 4 years from the treatments 98% of success were obtained for the group of patients treated with the traditional protocol and 100% for the digital protocol. At each time interval a significant difference in peri-implant crestal bone loss between the two groups was detected; with an average Marginal Bone Loss (MBL) at 4 years of 1.12 ± 0.26 mm in the traditional group and 0.83 ± 0.11 mm in the digital group. Patients belonging to the digital group have judged the immediate loading (92%), digital smile preview (93%), the mock-up test (98%) and guided surgery (94%) as very effective. All patients treated with a digital method reported lower values of during-surgery and post-surgery pain compared to patients rehabilitated using traditional treatment. In conclusion, the totally digital protocol described in the present study represents a valid therapeutic alternative to the traditional “All on Four” protocol for implant-supported rehabilitations of edentulous dental arches.

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A pilot study on immediate loading dental implants

Journal of Dental Panacea ◽

10.18231/j.jdp.2021.016 ◽

2021 ◽

Vol 3 (2) ◽

pp. 73-77

Author(s):

Sandeep Mithapara ◽

Setu P. Shah ◽

Deval Mehta ◽

Sonal Madan ◽

Ekta Mistry

Keyword(s):

Bone Loss ◽

Dental Implants ◽

Immediate Loading ◽

Marginal Bone Loss ◽

Extraction Socket ◽

Extraction Site ◽

Significant Difference ◽

Implant Crown ◽

Distal Aspect

Evolution in the field of dental implantology made the replacement of missing tooth easy and quick. During initial phase of evolution, there was a need of 3 to 6 months of healing period to get teeth on implants but with advancement of technology and research, immediate replacement of missing teeth without waiting period could become a possibility. To access the efficacy of immediate loading in dental implantology using Hexacone® (IHDE DENTAL - Switzerland) dental implant. The objectives were to evaluate pain, infection, recession, loosening of abutment, fracture of implant/crown, de-cementation, peri-implant radiolucency, and marginal bone loss. Five patients (3 male and 2 female) who needed teeth replacement were included in the study. Among 5 patients, 3 patients needed single tooth replacement and the remaining 2 needed segmental replacement. Out of 7 implants 6 implants were placed in the healed bone and 1 was placed in the extraction socket. In case of healed bone, permanent prosthesis were given on 3 day. In case of extraction site, temporary acrylic crown was given on 2 day, which was replaced by permanent prosthesis after 3 month. These patients were evaluated at 7 day, 1 month, 3 months, 6 months and 12 months clinically and radiographically. Infection, prosthetic problems, peri-apical radiolucency, and implant mobility were not observed and marginal bone loss was observed during follow-up periods. On 6 months follow up, 0.5mm and 0.45mm marginal mean bone loss was observed on mesial and distal aspect respectively whereas the same was 1.24mm and 1.14 mm on 12 months follow-up respectively.The immediate loading for dental implants is a successful procedure that decreases the time for the patients to obtain a final restoration satisfying both esthetical and functional problems. Immediately loaded implants survive equally well in extraction socket. No significant difference was seen in survival when implants were placed in healed bone and extraction socket.

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Effects of Immediate and Delayed Loading Protocols on Marginal Bone Loss Around Implants in Unsplinted Mandibular Implant-Retained Overdentures: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-61066/v1 ◽

2020 ◽

Author(s):

Wei Liu ◽

He Cai ◽

Junjiang Zhang ◽

Jian Wang ◽

Lei Sui

Keyword(s):

Bone Loss ◽

Cohort Studies ◽

Subgroup Analysis ◽

Meta Analysis ◽

Grey Literature ◽

Risk Of Bias ◽

Immediate Loading ◽

Marginal Bone Loss ◽

Promising Alternative ◽

Significant Difference

Abstract Background: Immediate loading has recently been introduced into unsplinted mandibular implant-retained overdentures for the management of edentulous patients due to their increasing demand on immediate aesthetics and function. However, there is still a scarcity of meta-analytical evidence on the efficacy of immediate loading compared to delayed loading in unsplinted mandibular implant-retained overdentures. The purpose of this study was to compare the marginal bone loss (MBL) around implants between immediate and delayed loading of unsplinted mandibular implant-retained overdentures.Methods: Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and cohort studies quantitatively comparing the MBL around implants between immediate loading protocol (ILP) and delayed loading protocol (DLP) of unsplinted mandibular overdentures were included. A systematic search was carried out in PubMed, EMBASE, and CENTRAL databases on April 28, 2020. “Grey” literature was also searched. A meta-analysis was conducted to compare the pooled MBL of two different loading protocols of unsplinted mandibular overdentures through weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). The subgroup analysis was performed between different attachment types (i.e. Locator attachment vs. ball anchor). The risk of bias within and across studies were assessed using the Cochrane Collaboration’s tool, the Newcastle-Ottawa scale, and Egger’s test. Results: Of 305 records, five RCTs and two cohort studies were included and evaluated, which totally contained 191 participants with a follow-up of no less than 12 months. The MBL of ILP group showed no significant difference with that of DLP group (WMD 0.04, CI -0.13 to 0.21, P > .05). The subgroup analysis revealed similar results between the two different loading groups restored with Locator attachments or ball anchors (P > .05). Apart from one RCT (20%) with a high risk of bias, four RCTs (80%) showed a moderate risk of bias. Two prospective cohort studies were proved with acceptable quality. Furthermore, the Egger’s test indicated no significant bias among seven included studies (P > .05). Conclusions: For unsplinted mandibular implant-retained overdentures, the MBL around implants after ILP seems comparable to that of implants after DLP. Immediate loading may be a promising alternative to delayed loading for the management of unsplinted mandibular implant-retained overdentures. PROSPERO registration number: CRD42020159124

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Multicenter Retrospective Analysis of Implant Overdentures Delivered with Different Design and Attachment Systems: Results Between One and 17 Years of Follow-Up

Dentistry Journal ◽

10.3390/dj6040071 ◽

2018 ◽

Vol 6 (4) ◽

pp. 71 ◽

Cited By ~ 9

Author(s):

Marco Tallarico ◽

Luca Ortensi ◽

Matteo Martinolli ◽

Alessio Casucci ◽

Emiliano Ferrari ◽

...

Keyword(s):

Patient Satisfaction ◽

Computer Aided Design ◽

Statistical Significance ◽

Survival Rates ◽

Biological Parameters ◽

Success Rates ◽

Marginal Bone Loss ◽

Mechanical Complications ◽

Computer Aided

Purpose: To analyze implant and prosthetic survival rates, complications, patient satisfaction, and biological parameters of patients rehabilitated with implant overdentures (IOV) on splinted and nonsplinted implants and different attachment systems, in function for one to 17 years. Methods: This retrospective study evaluated data collected from patients rehabilitated with implant overdentures between January 2001 and December 2016 in nine different centers. Outcome measures were implant and prosthetic success rates, mechanical complications, marginal bone loss (MBL), oral health impact profile (OHIP), bleeding on probing, and plaque index. Results: A total of 581 implants were installed in 194 patients. Patients were followed for a mean period of 60.6 months (range 6–206). Eighty-nine patients received 296 low profile attachment (OT Equator), 62 patients received 124 ball attachments, and 43 patients received 107 Locator attachments. In eighty-three patients the implants were splinted with computer aided design/computer aided manufacturing (CAD/CAM) or casted bar. At the last follow-up, 10 implants failed in eight patients. Statistical significance was found for failed prostheses (P = 0.0723) and complications (P = 0.0165), with better values for splinted implants. No statistically significant differences were found in proportion of implant and prosthetic failure (P > 0.05). At a five-year follow-up, proportion of complications (P = 0.0289) and failed prostheses (P = 0.0069) were statistically higher for IOV on Locator attachments. No difference was founded in MBL at one- and two-year follow-up between different attachment systems (P > 0.05). Statistically significant improvement in all the OHIP categories was reported in all the patients, after one year of function. Conclusions: Implant overdenture showed high implant and prosthetic survival rates, low complications, high patient satisfaction, and good biological parameters in the long-term follow-up. Splinting the implants may reduce number of mechanical complications. Locator attachments showed higher number of complications. Further studies are needed to confirm these preliminary results.

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One-Year Results of a Randomized Controlled Clinical Trial of Immediately Loaded Short Implants Placed in the Lower Posterior Single Molar Using a Complete Digital Workflow

Applied Sciences ◽

10.3390/app9071282 ◽

2019 ◽

Vol 9 (7) ◽

pp. 1282 ◽

Cited By ~ 2

Author(s):

Yeon-Wha Baek ◽

Young-Jun Lim ◽

Jungwon Lee ◽

Ki-Tae Koo ◽

Myung-Joo Kim ◽

...

Keyword(s):

Clinical Trial ◽

Soft Tissue ◽

Bone Loss ◽

Controlled Clinical Trial ◽

Insertion Torque ◽

Marginal Bone Loss ◽

Model Free ◽

Short Implants ◽

Significant Difference ◽

Computer Aided

The purpose of this randomized clinical trial is to evaluate immediately loaded single implants with varying lengths in the posterior mandible using a fully digital, model-free prosthetic-driven implant planning pathway, and to compare clinical and radiological outcomes of short and long implants. The 52 patients with the single tooth missing in the posterior molar regions of the mandible were randomly assigned to the control (CMI IS-III active® long implant; 5.0 × 10 mm) and experimental (CMI IS-III active® short implant; 5.5 × 6.6, 7.3, 8.5 mm) groups. For each patient, a single implant was placed using the computer aided surgical template and all prostheses were fabricated by means of computer-aided design/computer-aided manufacturing (CAD/CAM) system on the virtual model. The patients received provisional and definitive monolithic zirconia prostheses at 1 week and 12 weeks after implant surgery, respectively. The implant stability quotient (ISQ) measurements and periapical radiographs were taken and peri-implant parameters were evaluated at 1, 3, 4, 8, 12, 24, 36, and 48 weeks after surgery. Nineteen long implants and 27 short implants were finally used for the statistical analysis. There was no significant difference between the groups in terms of insertion torque, ISQ values (except 3 weeks), marginal bone loss, and peri-implant soft tissue parameters (p > 0.05). Both groups exhibited no stability dip during the early phase of healing. The average marginal bone loss from the baseline of implant placement for the control and experimental groups was −0.07 and 0.03 mm after 12 weeks and 0.06 and 0.05 mm after 48 weeks. All of the soft tissue parameters were within normal limits. Within the limits of the short term follow up, immediate loading of short single implants can be considered as one of predictable treatment modality in mandible with reduced bone height when primary stability can be achieved.

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Treatment of Full and Partial Arches with Internal-Conical-Connection Dental Implants: Clinical Results after 5 Years of Follow-Up

Applied Sciences ◽

10.3390/app10238709 ◽

2020 ◽

Vol 10 (23) ◽

pp. 8709

Author(s):

Diego Lops ◽

Riccardo Guazzo ◽

Alessandro Rossi ◽

Antonino Palazzolo ◽

Vittorio Favero ◽

...

Keyword(s):

Bone Loss ◽

Dental Implants ◽

Clinical Results ◽

Marginal Bone Loss ◽

Significant Difference ◽

Distal Aspect ◽

The Stability ◽

Maxilla And Mandible ◽

Implant Loading

The aim of the present investigation is to evaluate the implant therapy outcomes over a period of 5 years and to analyze several patient risk factors influencing the stability of the peri-implant tissues. Seventy-eight patients were consecutively treated between 2009 and 2017 and restored with implant-supported fixed prostheses. The following inclusion criteria were considered: partial or complete edentulism; residual bone volume of at least 3.3 mm in diameter and 8 mm in length; a favorable relationship between maxilla and mandible; at least a minimum 5 year follow-up for each implant included in the statistical analysis. Intraoral radiographs were taken at implant loading and every 12 months during the follow-up visits. They were subsequently stored on a personal computer and analyzed to determine the changes in bone level. Seventy-eight patients receiving 209 implants completed a minimum follow-up period of 5 years. One-hundred dental implants were inserted in the maxilla while 109 were placed in the mandible. Eleven (14.1%) out of 78 treated patients who received 29 (13.9%) dental implants were considered as drop-outs. On the whole, peri-implantitis was diagnosed in three implants. The average final pocket probing depth at implant level was 2.5 ± 1.2 mm. The average final bone loss after 5 years was 0.3 ± 0.4 mm, both at the mesial and distal aspect of the implant. The effects of the prosthesis type, sex and implant site did not statistically influence the marginal bone loss; on the contrary, a statistically significant difference regarding marginal bone loss was detected between smoker and non-smoker patients (p = 0.021). Implants with internal-conical abutment connection showed stable peri-implant bone levels at the medium-term follow-up. Nevertheless, further prospective long-term clinical studies are necessary to confirm these data.

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Immediate Loading of Implants Placed by Guided Surgery in Geriatric Edentulous Mandible Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084125 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4125

Author(s):

Eugenio Velasco-Ortega ◽

Alvaro Jiménez-Guerra ◽

Ivan Ortiz-Garcia ◽

Jesús Moreno-Muñoz ◽

Enrique Núñez-Márquez ◽

...

Keyword(s):

Bone Loss ◽

Clinical Outcomes ◽

Previous History ◽

Immediate Loading ◽

Marginal Bone Loss ◽

Guided Surgery ◽

Edentulous Mandible ◽

Long Term Follow Up ◽

History Of

The aim of this study was to show the clinical outcomes of the immediate loading of implants inserted by guided surgery in edentulous mandible patients. Edentulous mandible patients were diagnosed with oral examination, cone beam computerized tomography and diagnostic casts for intermaxillary relations and treated with 8–10 implants for rehabilitation with guided surgery and immediate loading. After flapless surgery, implants were loaded with an immediate acrylic temporary prosthesis. After a period of six months, a ceramic definitive full-arch prosthesis was placed. A total of 22 patients (12 females and 10 males) were treated with 198 implants. Eleven patients (50%) had a previous history of periodontitis. Six patients (27.3%) were smokers. The follow-up was 84.2 ± 4.9 months. Clinical outcomes showed a global success rate of 97.5% of implants. Five implants were lost during the healing phase with provisional prosthesis. Twenty-two fixed full-arch rehabilitations were placed in the patients over the 193 remaining implants. Mean marginal bone loss was 1.44 mm ± 0.45 mm. Six patients (27.3%) showed some kind of mechanical prosthodontic complication. Eighteen (9.3%) of the 193 remaining implants were associated with peri-implantitis. The antecedents of peri-implantitis are critical elements for the survival of the implants. The loss of implants was significant in patients who smoked up to 10 cigarettes, compared to non-smokers. Peri-implantitis is one of the key elements in the long-term follow-up of implants and it was more manifest in smoking patients, and in those with a history of peri-implantitis. Marginal bone loss was more significant in smokers. Full-arch rehabilitation is presented as a predictable alternative with minor fatigue problems that are easily solvable.

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A Randomized Clinical Trial Comparing Immediate Loading and Delayed Loading of Single-Tooth Implants: 5-Year Results

Journal of Clinical Medicine ◽

10.3390/jcm10051077 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1077

Author(s):

Björn Gjelvold ◽

Jenö Kisch ◽

Bruno R. Chrcanovic

Keyword(s):

Bone Loss ◽

Immediate Loading ◽

Implant Survival ◽

Marginal Bone Loss ◽

Randomized Clinical Study ◽

Maxillary Tooth ◽

Bone Level ◽

Implant Crown ◽

Treatment Procedures

The aim of this prospective randomized clinical study was to compare the clinical treatment outcome for single dental implants submitted to either immediate loading (IL) or delayed loading (DL) after 5 years of follow-up. Fifty patients with a missing maxillary tooth (15–25) were randomly allocated to either the IL or DL. The treatment procedures included implant installation in healed sites, temporary screw-retained crown and replacement with a permanent single implant crown. The two groups were evaluated with regard to implant survival, marginal bone level, papillae index, pink and white esthetic score (PES, WES). At the 5-year follow-up the implant survival rate was 100% and 95.8% for IL and DL, respectively. Implant success rate was 91.7% and 83.3% for IL and DL, respectively. The mean ± SD marginal bone loss for IL and DL was −0.50 ± 0.73 mm and −0.54 ± 0.65 mm, respectively. (p = 0.782). Statistically significant less marginal bone loss was found non-smokers (p = 0.021). No statistically significant differences were found for IL and DL concerning papillae index PES and WES after 5 years. This study suggests that implant-supported single crowns in the maxillary aesthetic zone can present similar results with respect to either IL or DL after 5 years.

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Rehabilitation of the Completely Edentulous Mandible by All-on-Four Treatment Concept: A Retrospective Cohort Study with Up to 10 Years Follow-Up

Medicina ◽

10.3390/medicina58010010 ◽

2021 ◽

Vol 58 (1) ◽

pp. 10

Author(s):

Tommaso Grandi ◽

Luca Signorini

Keyword(s):

Survival Rate ◽

Bone Loss ◽

Treatment Concept ◽

Marginal Bone Loss ◽

Mechanical Complications ◽

Prosthesis Survival ◽

Edentulous Mandible ◽

Significant Difference

(1) Background and Objectives. Currently, there are no definitive long-term data about clinically significant difference in the failure of prosthesis and implant or marginal bone loss related to the rehabilitation of the completely edentulous mandible by all-on-four treatment concept. The main aim of present investigation was to report the long-term outcomes (10-years follow-up) of complete-arch mandibular rehabilitations based on the all-on-four concept. (2) Materials and Methods. Patients in need of extractions of teeth due to the occurrence of caries and/or severe periodontal disease and patients presented with edentulous mandibles were enrolled to the study. A total of 96 participants (mean follow-up period after intervention of 3185.2 days) were enrolled in the study. Participants were evaluated at the first visit, 10 days after intervention and every year after the intervention. Implant and prosthesis survival, bone loss and both local biological and mechanical complications were evaluated during the follow-up period. (3) Results. An implants’ survival rate of 97.9% was observed at the end of the follow-up period. Biological complications were reported in 19.8% of patients, whereas mechanical complications were reported in 27.1% of cases. The average marginal bone level at baseline was −0.03 mm. A significant marginal bone loss was observed after 10-years follow-up (2.5 mm). Binary logistic regression analysis showed significant association between smoke and both marginal bone loss and local biological complications. Lastly, a significant association was observed between bruxism and mechanical complications. (4) Conclusions. The high implant and prosthesis survival rate and the moderate incidence of biological and mechanical complications observed in present investigation can be associated to several factors such as high implant primary stability, prosthetic design, and control of the occlusal forces.

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Effects of immediate and delayed loading protocols on marginal bone loss around implants in unsplinted mandibular implant-retained overdentures: a systematic review and meta-analysis

BMC Oral Health ◽

10.1186/s12903-021-01486-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wei Liu ◽

He Cai ◽

Junjiang Zhang ◽

Jian Wang ◽

Lei Sui

Keyword(s):

Bone Loss ◽

Cohort Studies ◽

Failure Rate ◽

Subgroup Analysis ◽

Meta Analysis ◽

Risk Of Bias ◽

Immediate Loading ◽

Marginal Bone Loss ◽

Promising Alternative ◽

Significant Difference

Abstract Background Immediate loading has recently been introduced into unsplinted mandibular implant-retained overdentures for the management of edentulous patients due to their increasing demand on immediate aesthetics and function. However, there is still a scarcity of meta-analytical evidence on the efficacy of immediate loading compared to delayed loading in unsplinted mandibular implant-retained overdentures. The purpose of this study was to compare the marginal bone loss (MBL) around implants between immediate and delayed loading of unsplinted mandibular implant-retained overdentures. Methods Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and cohort studies quantitatively comparing the MBL around implants between immediate loading protocol (ILP) and delayed loading protocol (DLP) of unsplinted mandibular overdentures were included. A systematic search was carried out in PubMed, EMBASE, and CENTRAL databases on December 02, 2020. “Grey” literature was also searched. A meta-analysis was conducted to compare the pooled MBL of two different loading protocols of unsplinted mandibular overdentures through weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). The subgroup analysis was performed between different attachment types (i.e. Locator attachment vs. ball anchor). The risk of bias within and across studies were assessed using the Cochrane Collaboration’s tool, the Newcastle–Ottawa scale, and Egger’s test. Results Of 328 records, five RCTs and two cohort studies were included and evaluated, which totally contained 191 participants with 400 implants. The MBL of ILP group showed no significant difference with that of DLP group (WMD 0.04, CI − 0.13 to 0.21, P > .05). The subgroup analysis revealed similar results with Locator attachments or ball anchors (P > .05). Apart from one RCT (20%) with a high risk of bias, four RCTs (80%) showed a moderate risk of bias. Two prospective cohort studies were proved with acceptable quality. Seven included studies have reported 5.03% implant failure rate (10 of 199 implants) in ILP group and 1.00% failure rate (2 of 201 implants) in DLP group in total. Conclusions For unsplinted mandibular implant-retained overdentures, the MBL around implants after ILP seems comparable to that of implants after DLP. Immediate loading may be a promising alternative to delayed loading for the management of unsplinted mandibular implant-retained overdentures. PROSPERO registration number: CRD42020159124.

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Soft Tissue Evaluation of an Immediate Esthetic Zone Single Implant with a Stereolithographic Guide Using 3D Reconstruction and a CAD/CAM Customized Titanium Anatomic Abutment

Applied Sciences ◽

10.3390/app10051678 ◽

2020 ◽

Vol 10 (5) ◽

pp. 1678

Author(s):

Tae-Heung Kim ◽

You-Kyoung Oh ◽

Chang-Mo Jeong ◽

Edward Chengchuan Ko ◽

George K. Sándor ◽

...

Keyword(s):

Soft Tissue ◽

Computer Aided Design ◽

Anterior Maxilla ◽

Implant Placement ◽

Significant Difference ◽

Computer Aided ◽

Cad Cam ◽

One Year ◽

Single Implant

The replacement of an unrestorable tooth with a single implant-supported prosthesis is a treatment with predictable and successful outcomes. The anterior maxilla region is a complicated site for such treatment, due to its esthetic, functional, and physiological sensitivity. The purpose of this study was to evaluate the changes in the soft tissue following an immediate implant procedure using guided surgery in combination with a computer-aided design and computer-aided manufacturing (CAD/CAM) customized titanium anatomic abutment in the esthetic zone. A total of 13 patients who had been treated with an immediate post-extraction implant placement and an immediate provisional restoration were included in the study. The changes in the soft tissue dimension, interdental papilla, and esthetic score were evaluated with a follow-up of at least one year. There was no significant change in the midfacial mucosal status when compared to the pre-treatment situation. The recession of the mesial papillary height was 0.32 mm and the distal papillary height was 0.10 mm. The mean horizontal change in the labial mucosa was 0.32 ± 0.83 mm. There was no significant difference between the mesial papilla index and the distal papilla index. The pink esthetic score value prior to treatment was 11.16, and at one-year follow-up, 10.25. Within the limitations of this study, the immediate post-extraction implant placement procedure with a stereolithographic guide and a provisionalization with a CAD/CAM customized titanium anatomic abutment may be a treatment option with predictable outcomes for the replacement of teeth in the esthetic zone.

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